Key Points

The addition of BV to AVD was associated with an improvement of 0.56 QALYs compared with standard ABVD.

Acquisition costs of BV in first-line treatment would need to be substantially reduced to achieve ICERs reflecting currently acceptable levels.

In a cost-effectiveness analysis reported in the Journal of Clinical Oncology, Huntington et al found that the cost of brentuximab vedotin (Adcetris) would need to be reduced in order for the combination of the agent with chemotherapy in first-line treatment of stage III or IV Hodgkin lymphoma to meet currently acceptable cost-effectiveness thresholds.

Study Details

The analysis was based on data from the recent ECHELON-1 trial, in which first-line brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) reduced the risk of disease progression in stage III or IV Hodgkin lymphoma compared with standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]). As summarized by the authors, AVD+BV was associated with a significant 23% reduction in risk of progression, death, or incomplete response to first-line therapy leading to subsequent anticancer treatment (modified progression-free survival), representing an absolute reduction in disease progression of 4.9%. The analysis was based on BV pricing at U.S. $6,970 per 50-mg vial. Lifetime direct health-care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for AVD+BV vs ABVD from a U.S. payer perspective.

Cost-Effectiveness Outcomes

AVD+BV was associated with an improvement of 0.56 QALYs compared with treatment with standard ABVD. Incorporation of BV into first-line therapy was associated with higher lifetime health-care costs ($361,137 vs $184,291), with the ICER for AVD+BV calculated at $317,254 per QALY. On this basis, acquisition costs for BV used in the first-line setting would have to be reduced by 56% to 73% to achieve ICERs of currently acceptable levels of $150,000–$100,000 per QALY.

The investigators concluded, “Substituting BV for bleomycin during first-line therapy for stage III or IV [Hodgkin lymphoma] is unlikely to be cost-effective under current drug pricing. Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.”

The study was supported by grants from the National Heart, Lung, and Blood Institute and National Center for Advancing Translational Science of the National Institutes of Health.

Scott F. Huntington, MD, MPH, of the Section of Hematology, Yale School of Medicine, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.

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